Introduction to Communication Skills PDF

Introduction to Clinical Communication skills Dr Magda Abdel-Salam Professor of chest medicine Mansoura Univesity Intended learning Outcomes By the end of this session you should be able to:  Define what is meant by ‘clinical communication skills’, ‘the consultation’ in a medica...

Introduction to Clinical Communication skills Dr Magda Abdel-Salam Professor of chest medicine Mansoura Univesity Intended learning Outcomes By the end of this session you should be able to:  Define what is meant by ‘clinical communication skills’, ‘the consultation’ in a medical context, person-centred care, patient-centred care and holistic care  Describe the features of a patient-centred consultation, person-centred care, patient-centred care and holistic care  Know the patient perspectives  Know why person-centred care is important, its impact on the quality of care  List key communication skills which facilitate an effective, patient-centred consultation What is communication??? Communication (com|mu¦ni|ca¦tion) the imparting or exchanging of information by speaking, writing, or using some other medium the successful conveying or sharing of ideas and feelings Communication Skills The ability to communicate clearly & effectively with patients, families, physicians, nurses, pharmacists & other healthcare professionals Communication skills  Are the set of skills that enables a person to convey information so that it is received and understood. Examples: Active listening Demonstrating empathy (understand and share emotions of others) 6 Consultation (con¦sul|ta¦tion) The act of discussing something with someone before making a decision about it Meeting with an expert, especially a doctor, to get advice (or treatment) According to today’s standards physicians are required to have excellent: Knowledge Examination skills Problem-solving skills Communication skills 8  How patients rating their clinician  NOT knowledge-based  NOT skills-based BUT Based on communication and subtle cues They might be wrong..but their perception is everything. The good physician treats the disease; the great physician treats the patient who has the disease 9 The patient’s perspective Pre-formed thoughts/beliefs/worries Reason for seeking help now Expectations and preferences Influence of physical and psychological state The doctor’s perspective Information about the causes of problems (disease model) The structure of health care systems Professional regulation The doctor-patient partnership Listen to patients Ask for, and respect, their views about health Respond to their concerns and preferences Be honest and merciful with your patient Tasks in the consultation Define reasons for the patient’s attendance Consider other problems Choose appropriate action for each problem with the patient Achieve shared understanding of problem with the patient Involve the patient in management and encourage them to accept appropriate responsibility Use time and resources appropriately Establish or maintain rapport What do patients want? What do patients want? What patients want from their doctor Greeted me in a way that makes me feel comfortable Treated me with respect Showed interest in my ideas about my health Understood my main health concerns Paid attention to me (looked at me, listened carefully) Let me talk without interruptions Gave me as much information as I want What patients want from their doctor Talked in terms I could understand Checked to be sure I understood everything Encouraged me to ask questions Involved me in decisions as much as I want Discussed next steps, including any follow-up plans Showed care and concern Spent the right amount of time with me What is ‘clinical communication’?  take account of views and taking account of symptoms values also psychological, spiritual, respond honestly to questions social and cultural factors be open and honest if things go wrong Listen to Assess the patient’s patients conditions Work in Support partnership in caring for themselves patients with share information they will to empower them to improve patients need to make decisions and maintain their health about their care work collaboratively with give patients information colleagues; share information they want /need to know in a including when you hand over way they understand care Communication process Listen Collect data Interpret Focus How we communicate??? A. Taman 21  (A) Verbal communication A form of communication to transmit a message Done by speaking and writing. Aim of the communication is: People understand what we are trying to convey. Always remember the acronym KISS “ Keep It Short and Simple” A. Taman 22  Parts of the Verbal communication 1- Sender: This is the person that is delivering a message to a recipient. 2- Message: This refers to the information the sender is relaying to receiver. 3- Channel of communication: The transmission or method of delivering message. 4- Decoding: The interpretation of message. Decoding is performed by receiver. 5- Receiver: The person receiving the message. 6- Feedback: In some instances, the receiver might have feedback or a response for the sender. This starts an interaction. A. Taman 23 How does the communication process work? 24 Listening and interaction  To be an active listener what should you do? (Active listening skills ) A. Focus on what is being said. B. Repeat back. C. Face the speaker and make eye contact. D. Nod your head. E. Talk after the speaker finish. Active listening skills Communication Skills Active Listening Use face to face communication Focus on the patient (centre of attention) Conduct open relaxed & unhurried conversation Set aside all the distractions Prevent/minimize interruptions  Non-verbal communication Communication without using written or spoken words, but using voluntary or involuntary non-verbal signals 30 Types of non-verbal communication 32 What are the benefits of Effective Communication?? 33 Effective Communication is associated with: A better assessment of the patient’s clinical and emotional state.  Greater satisfaction Agreement with the proposed plan Greater treatment adherence, and recovery Improvements in pain tolerance Better mental health Shorter hospital stays, and fewer referrals Elements of Effective Communication with the patient Setting the stage Appropriate greeting, language Eliciting Open-ended, active listening, summarizing to convey information an understanding Sharing Assess what is known, what needs to be conveyed, information prioritize, allow questions; ask the patient to summarize understanding. Decision making Shared decision making. Help the patient take the decision—but do not make it for him or her Support Empathy and respect; be available  Questioning A) Closed questions B) Open questions A) Closed questions ‘YES’ or ‘NO’ answer or confirmation of something. For instance: ‘Would you like an extra pillow?’ ‘Can you tell me your address?’ A. Taman 36  Open questions Encourage patient to speak in more depth about something. They are open because they invite the person to open up. The best example of an open question in health care is: ‘How do you feel?’ , Is there anything else that you would like to tell me? 37 Communication Skills Poor communication between healthcare & pt → Inaccurate patient medication history taking Inappropriate therapeutic decisions Contribute to patient confusion Disinterest Non-compliance Poor communication between healthcare professionals → harm patient if information isn’t exchanged in appropriate manner Practising with patients We don’t expect you to ‘take a history’ at this point It is much more important to listen to the patient’s narrative Try and understand the patient’s experience What are their priorities? How does health and healthcare feature in this? What does the patient want? What affects the person’s choices? What to practice ‘Invest in the beginning’ Encourage the patient to feel welcome and comfortable  Warm room, sense of privacy, minimise distractions  Introduction  Good eye contact  Sitting at similar level  Arrangement of furniture  Chaperone if patient needs to undress What to practice Gathering information Explore the person’s perspective Use what you say and your body language to create a warm, supportive atmosphere LISTEN Don’t be afraid of silence – it gives people time to collect their thoughts ‘Open to closed question cone’ Reflect back and acknowledge what the patient has said when exploring a topic Working towards… Conduct professional and sensitive discussions with patients, relatives and colleagues as a clinical student Establish and maintain good working relationships Conduct an effective consultation to gather information from patients e.g.‘taking a medical history’ Adapt your communicative style to meet the needs of the patient and the aims of the consultation Demonstrate (in a simulated consultation) how to share information with patients and relatives and how to respond to difficult situations (e.g. breaking bad news) in the role of a junior doctor Reflect on consultations and critically appraise your own communication (in terms of strengths and areas to improve on) Person-centred care Is thinking about people using health services as partner in planning, developing and monitoring care which suits their needs Putting people at the centre of decision Is doing things with people, rather than to them Aspects of Person-Centred Care Respecting values Making sure of continuity between and within services Coordinating and integrating care Emotional support Involving family and friends Person- Centred Care is a high priority Help people to get their needs when they need Help people be more active in looking after themselves Help reducing the burden on health services  Holistic care Person should be treated as a whole ”wholistic” Consider the complete person, physically, psychologically, socially, and spiritually during management of health problem (comprehensive care) Communication Skills Lack of Privacy Don’t discuss patient dataor healthcare issues in public areas (hallway, walkways, elevators, Library). Don’t discuss patient information with family/friends. Converse with patients & discuss patient-specific information with other healthcare professionals in private areas (counselling room in the hospital & corner in community pharmacy). Close the room doors or curtains around the bed Barriers to Effective Communication A. Taman 49 A. Taman 50 A. Taman 51 A. Taman 52 Common Errors in Communication  Conclusion Effective communication is associated with positive medical outcomes. Doctors who communicate well are considered competent by patients. Verbal communication is complete and effective only when it is accompanied with proper use of non-verbal skills. Common errors in communication include lack of eye contact, use of inappropriate. gestures, use of the wrong tone, beside the incorrect choice of words.  Lack of empathetic listening, frequent interruptions, and being judgmental are perceived as major barriers to effective communication. eliciting feedback from patients and colleagues will be a way for improving communication. Before we go…. If you receive a bad evaluation from patients What will be your reaction? What will you do?